Myocardial-Infarction-Responsive Smart Hydrogels Targeting Matrix Metalloproteinase for On-Demand Growth Factor Delivery

Although in situ restoration of blood supply to the infarction region and attenuating pre-existing extracellular matrix degradation remain potential therapeutic approaches for myocardial infarction (MI), local delivery of therapeutics has been limited by low accumulation (inefficacy) and unnecessary diffusion (toxicity). Here, a dual functional MI-responsive hydrogel is fabricated for on-demand drug delivery to promote angiogenesis and inhibit cardiac remodeling by targeting upregulated matrix metalloproteinase-2/9 (MMP-2/9) after MI. A glutathione (GSH)-modified collagen hydrogel (collagen-GSH) is prepared by conjugating collagen amine groups with GSH sulfhydryl groups and the recombinant protein GST-TIMP-bFGF (bFGF: basic fibroblast growth factor) by fusing bFGF with glutathione-S-transferase (GST) and MMP-2/9 cleavable peptide PLGLAG (TIMP). Specific binding between GST and GSH significantly improves the amount of GST-TIMP-bFGF loaded in collagen-GSH hydrogel. The TIMP peptide enclosed between GST and bFGF responds to MMPs for on-demand release during MI. Additionally, the TIMP peptide is a competitive substrate of MMPs that inhibits the excessive degradation of cardiac matrix by MMPs after MI. GST-TIMP-bFGF/collagen-GSH hydrogels promote the recovery of MI rats by enhancing vascularization and ameliorating myocardium remodeling. The results suggest that on-demand growth factor delivery by synchronously controlling binding and responsive release to promote angiogenesis and attenuate cardiac remodeling might be promising for the treatment of ischemic heart disease.

Carboxymethyl Chitosan Modified Carbon Nanoparticle for Controlled Emamectin Benzoate Delivery: Improved Solubility, pH-Responsive Release, and Sustainable Pest Control

Environmentally friendly pesticide delivery systems have drawn extensive attention in recent years, and they show great promise in sustainable development of agriculture. We herein report a multifunctional nanoplatform, carboxymethyl chitosan modified carbon nanoparticles (CMC@CNP), as the carrier for emamectin benzoate (EB, a widely used insecticide), and investigate its sustainable antipest activity. EB was loaded on CMC@CNP nanocarrier via simple physisorption process, with a high loading ratio of 55.56%. The EB@CMC@CNP nanoformulation showed improved solubility and dispersion stability in aqueous solution, which is of vital importance to its practical application. Different from free EB, EB@CMC@CNP exhibited pH-responsive controlled release performance, leading to sustained and steady EB release and prolonged persistence time. In addition, the significantly enhanced anti-UV property of EB@CMC@CNP further ensured its antipest activity. Therefore, EB@CMC@CNP exhibited superior pest control performance than free EB. In consideration of its low cost, easy preparation, free of organic solution, and enhanced bioactivity, we expect, CMC@CNP will have a brilliant future in pest control and green agriculture.

[MNAT1 expression in non-small cell lung cancer and its biological cellular impact]

Objective: To investigate the expression and significance of MNAT1 in non-small cell lung cancer (NSCLC) and to explore the biological impact of MNAT1 expression in lung cancer cells at the cellular level and related signaling pathway. Methods: Forty-eight cases of NSCLC tissues and paired normal tissues was collected at Nanfang Hospital, Southern Medical University from 2015 to 2017. The expression level of MNAT1 was detected by immunohistochemistry, and the relationship between MNAT1 and clinicopathological features was analyzed. The expression of MNAT1 was detected in lung cancer cells, MNAT1 level was analyzed after knocking down in A549 and H322 cells by siRNA; Plasmid vector of overexpressing MNAT1 was constructed, followed by transfecting H1299 cells and observing proliferation and migration at the cellular level. Flow cytometry was used to analyze the effect of the expression of MNAT1 on cell cycle, and Western blot was used to explore the possible molecular mechanism of MNAT1 on cell proliferation and cell cycle. Results: Immunohistochemistry showed that the expression score of MNAT1 was (4.07±3.55) in normal lung tissue and (7.33±4.09) in NSCLC tissue (P<0.01), and correlated with lymph node metastasis. At the cellular level, MNAT1 promoted cell proliferation(P<0.05), migration(P<0.05) and cell cycle progression(P<0.01). Conclusions: MNAT1 may be involved in the development of non-small cell lung cancer.MNAT1 affects cell cycle and proliferation through the Akt/p21 pathway.

[Analysis of occupational pneumoconiosis in Jiangsu province from 2006 to 2017]

Objective: To analyze the characteristics and patterns of occupational pneumoconiosis in Jiangsu Province, China, from 2006 to 2017, and to provide a scientific basis for government departments to develop effective interventions and preventive strategies against occupational pneumoconiosis. Methods: The data of 9327 patients with occupational pneumoconiosis were retrieved from the online report of occupational pneumoconiosis in Jiangsu Province from 2006 to 2017. Excel worksheet and SPSS 20.0 software were used to organize and analyze the data, respectively. An epidemiological statistical analysis was performed on age of onset, length of dust exposure, type of work, industry category, type of pneumoconiosis, annual incidence of pneumoconiosis, regional distribution, enterprise scale, and economic category in those patients. Results: A total of 9 327 patients with occupational pneumoconiosis were reported in Jiangsu Province from 2006 to 2017. In those patients, 8 559 were newly diagnosed and 768 had advanced disease. The male-female ratio was 16.34:1.Patients with stage I pneumoconiosis(6 994, 74.99%) were dominant in all the patients. The mean age of onset and length of dust exposure were 58.5±10.7 and 15.3±10.9 years, respectively. Most of the patients (6 012, 64.46%) had an age of onset between 50 and 69 years. For the length of dust exposure, the highest percentage was observed in patients exposed for no more than 5 years (2 231, 23.92%).The largest number of patients diagnosed with pneumoconiosis(1 200, 12.87%) was reported in 2010. Most of the patients(7 012, 75.18%) were from four cities, i.e, Wuxi (2 090, 22.41%), Yancheng (1 987, 21.30%), Suzhou (1 552, 16.64%), and Xuzhou (1 383, 14.83%). In all the patients, the incidence of silicosis (6791, 72.81%) was highest, followed by coal worker pneumoconiosis (1 364, 14.62%) and electric welder pneumoconiosis (563, 6.04%).Pneumoconiosis complicated by tuberculosis was found in 28 (0.3%) patients.A total of 1616 (17.33%) patients were reported in health, social security, and social welfare industries, while 1474 (15.80%) patients worked for coal mining and washing. Rock drillers (2 818, 30.21%) were dominant in those patients.State-owned economic enterprises reported the largest number of patients(5 441, 58.34%).Patients from small enterprises (4 323, 46.35%) had the highest percentage. Conclusion: Pneumoconiosis is an occupational disease with a high incidence in Jiangsu Province. Pneumoconiosis patients show an industry- and job-centered distribution. The length of dust exposure is decreasing.

[The effect of hypothalamic-pituitary-thyroid axis hormone levels and depression in obstructive sleep apnea-hypopnea syndrome]

Objective: To explore the change of hypothalamic-pituitary-thyroid axis hormones and it's role in depression in obstructive sleep apnea-hypopnea syndrome. Methods: Seventy-three male OSAHS patients [age (39±11) years] and 13 male controls [age (36±7.5) years] were enrolled from August 2013 to May 2017 in the 1(st) Hospital of China Medical University. Overnight polysomnography and depression were assessed. The serum TRH, TSH, FT4 and FT3 levels were measured on the next morning. The relationship between depression and hypothalamic-pituitary-thyroid axis was analyzed. Results: Compared with the control group, severe hypoxia group had higher serum FT3 level [(4.5±0.6) ng/L vs. (5.4±0.7)ng/L, P<0.05)] and depression score (30±7 vs. 40±10, P<0.05). Further analysis revealed that serum FT3 level (5.0±0.5 ng/L vs. 5.5±0.7ng/L, P<0.05) and FT4 level [(16.2±1.9) ng/L vs. (18.2±2.3) ng/L, P<0.05] were lower in the patients with depression than those without. Conclusion: The decrease of serum FT3 and FT4 levels in OSAHS patients with severe hypoxia was closely related to the occurrence of depression.

[The influence of chronic intermittent hypoxia on hypothalamic-somatotropic axis in rats]

Objective: To investigate the effects of chronic intermittent hypoxia on somatotropic axis hormone levels in rats. Methods: Mature male Wistar rats were exposed to air or intermittent hypoxia randomly.The serum levels of growth hormone-releasing hormone (GHRH), growth hormone (GH) and somatostatin (SS) were measured before exposure, at the 4th, 8th, and 12th week after exposure. Different hormone levels in two groups were compared and analyzed. Results: Compared with the control group, GHRH levels in chronic intermittent hypoxic group showed a significant decline at the 4th week [(732.77±46.99)pg/ml vs. (893.59±40.00) pg/ml, P<0.05], while SS levels at the 8th week [(30.71±2.27) pg/ml vs. (44.69±3.36) pg/ml, P<0.05] and GH levels at the 12th week [(1.20±0.29) ng/ml vs. (2.06±0.13) ng/ml, P<0.05] were similarly reduced. As the duration of intermittent hypoxia was prolonged, the GHRH levels did not decrease further [4th week (732.77±46.99) pg/ml vs. 8th week (607.54±131.61) pg/ml vs. 12th week (730.05±40.63) pg/ml, P>0.05].However, the serum SS levels decreased further from the 8th week to the 12th week [(30.71±2.27) pg/ml vs. (24.41±4.06) pg/ml, P<0.05]. Conclusion: Chronic intermittent hypoxia might inhibit the function of somatotropic axis. Hypothalamic hormones are the earlyonesto be influenced, thereafter the entire axis.

[Collision tumor in the hypopharynx: a case report]

SummaryA collision tumor consists of two different histologically distinct and topographically independent tumors merging in the same mass. In the head and neck area, they are rare and only a few cases have been reported in the hypopharynx. It is difficult to choose to treat this disease.

[Efficacy and safety of active transfer of plaque versus provisional stenting with drug-eluting stents for the treatment of coronary bifurcation lesions]

Objective: To compare the efficacy and safety of active transfer of plaque (ATP) versus provisional stenting (PS) with drug-eluting stents (DES) for the treatment of coronary bifurcation lesions. Methods: A total of 1 136 patients with bifurcation lesions hospitalized in 6 selected hospitals between January 2010 and January 2014 were included in this prospective observational trial, patients were divided into either ATP (n=560) or PS group (n=576) accordingly. The primary endpoint was target lesion revascularization within 1 year, and the second endpoints were all-cause death, cardiogenic death, myocardial infarction, stent thrombosis, stroke, recurrent angina within 1 year. Results: There were no significant differences in age, sex, hypertension, diabetes, hyperlipidemia and smoking history between the two groups (P>0.05). The incidence of TIMI blood flow <3 grade in the side branch (1.6%(9/560) vs. 7.5% (43/576), P<0.01), acute occlusion of the side branch (1.3%(7/560) vs. 7.1%(41/576), P<0.01) and implanted stents of side branch (1.8%(10/560) vs. 7.8% (45/576), P<0.01) were significantly lower in the ATP group than those in the PS group. During the one year follow up, the rate of target lesion revascularization was similar between ATP group and PS group (4.6%(26/560) vs. 4.0%(23/576), P=0.66). Conclusions: The effectiveness and safetyof ATP techniquein the patients with coronary bifurcation lesions is comparable to the PS technique. However, ATP technique is superior to PS technique on effectively reducing the incidence of implanted stents in the side branch.

[Preliminary clinical outcomes of patients with acute myocardial infarction complicated with cardiogenic shock treated with PIE-2R model]

Objective: To investigate the clinical experience of application of PIE-2R model to treat patients with acute myocardial infarction (AMI) complicated with cardiogenic shock (CS). Methods: A total of 129 patients with AMI complicated with CS treated with PIE-2R model, featuring in respiratory management, pacemaker, mechanical circulatory support (MCS) and timely myocardial revascularization, admitted in Beijing Anzhen Hospital, Capital Medical University between January 2013 and December 2018, were consecutively enrolled. Patient's baseline characteristics, implementation of each component of PIE-2R model, and in-hospital mortality were analyzed. Results: Participants' average age was 60 years, and male patients accounted for 78%. In all enrolled patients, 61% were implanted with temporary pacemaker due to severe bradyarrhythmia, 73% were treated with mechanical ventilation because of acute respiratory failure or pulmonary edema, and all patients were treated with percutaneous coronary intervention (PCI) supported by MCS (85% of cases with intra-aortic balloon pump and 15% of cases with veno-arterial extracorporeal membrane oxygenation or Impella), with an average first medical contact to MCS time of 87 minutes, and 79% were treated with second-generation drug-eluting stent. Eventually, after emergency treatment using PIE-2R model, 69 patients survived and in-hospital mortality was 46.5%. Conclusion: The application of PIE-2R model in patients with acute myocardial infarction complicated with cardiogenic shock is feasible, with a lower in-hospital mortality.

Whole-exome sequencing of ovarian cancer families uncovers putative predisposition genes

Despite the identification of several ovarian cancer (OC) predisposition genes, a large proportion of familial OC risk remains unexplained. We adopted a two-stage design to identify new OC predisposition genes. We first carried out a large germline whole-exome sequencing study on 158 patients from 140 families with significant OC history, but without evidence of genetic predisposition due to BRCA1/2. We then evaluated the potential candidate genes in a large case-control association study involving 381 OC cases in the Cancer Genome Atlas project and 27,173 population controls from the Exome Aggregation Consortium. Two new putative OC risk genes were identified, namely, ANKRD11, a putative tumor suppressor, and POLE, an enzyme involved in DNA repair and replication. These two genes likely confer moderate OC risk. We performed in vitro experiments and showed an ANKRD11 mutation identified in our patients markedly lowered the protein expression by compromising protein stability. Upon future validation and functional characterization, these genes may shed light on cancer etiology along with improving ascertainment power and preventive care of individuals at high risk of OC.

Improved Charge Transfer and Hot Spots by Doping and Modulating the Semiconductor Structure: A High Sensitivity and Renewability Surface-Enhanced Raman Spectroscopy Substrate

Here, we develop a new method to improve the surface-enhanced Raman spectroscopy (SERS) activity of ZnO using Mg doping combined with noble metals. Highly aligned silver nanoparticles (AgNPs) decorated on an array of Mg-doped ZnO (MZO@Ag) were fabricated. Using rhodamine 6G as the probe molecule, SERS indicated that the MZO@Ag substrate possesses perfect sensitivity, homogeneity, and chemical stability. The enhancement mechanism of this substrate was analyzed in detail, and finite-difference time-domain (FDTD) simulations were used to examine "hot spot" distribution which generated gaps between the balls, the rods, and the stems. FDTD simulation calculated ( E/ E₀)⁴ to be 2.5 × 10⁶. Furthermore, the prepared substrates could degrade the target molecules in situ irradiated by visible light irradiation over the course of 40 min and then efficiently recover detectability through a recycling process. Our substrates were easy to fabricate, self-cleaning, and reusable. They are expected to provide new opportunities for the use of SERS in biological sensors, biomedical diagnostics, and food safety.

Muscle injury promotes heterotopic ossification by stimulating local bone morphogenetic protein-7 production

Background

Heterotopic ossification (HO) is a pathological condition of abnormal bone formation in soft tissue, which causes pain and restricted range of motion in patients. There are two broad categories of HO, hereditary and acquired. Although different types of HO do not use identical mechanistic pathways of pathogenesis, muscle injury appears to be a unifying feature for all types of HO. However, little is known about the mechanisms by which muscle injury facilitates HO formation.

Objective and method

This study aimed to explore the cellular and molecular mechanisms linking muscle injury to HO by using cardiotoxin to induce muscle injury in a bone morphogenetic protein-2 (BMP-2)-induced HO mouse model.

Results

We found that muscle injury augmented HO formation and that this effect was correlated with BMP signalling activation and upregulation of BMP-7 expression at the early phase of HO progression. We further demonstrated that inhibition of BMP-7 activity in vitro suppressed the osteogenesis-promoting effect of conditioned medium derived from injured muscle tissue and in vivo reduced the volume of HO formation. We also showed that antiinflammatory drug treatment reduced the volume of HO with concomitant reduction in BMP-7 production.

Conclusion

In summary, our study has identified BMP-7 as a key osteoinductive factor in injured muscle that facilitates HO formation.

The translational potential of this article

Our results provide a candidate mechanistic rationale for the use of antiinflammatory drugs in the prevention of HO.

Tests of General Relativity with GW170817

The recent discovery by Advanced LIGO and Advanced Virgo of a gravitational wave signal from a binary neutron star inspiral has enabled tests of general relativity (GR) with this new type of source. This source, for the first time, permits tests of strong-field dynamics of compact binaries in the presence of matter. In this Letter, we place constraints on the dipole radiation and possible deviations from GR in the post-Newtonian coefficients that govern the inspiral regime. Bounds on modified dispersion of gravitational waves are obtained; in combination with information from the observed electromagnetic counterpart we can also constrain effects due to large extra dimensions. Finally, the polarization content of the gravitational wave signal is studied. The results of all tests performed here show good agreement with GR.

[Epidemiological characteristics of pesticide poisoning in Xuzhou city from 2005 to 2017]

Objective: To understand the characteristics and causes of pesticide poisoning in Xuzhou city, and provide basis for formulating prevention and control measures. Methods: The cases of pesticide poisoning in Xuzhou City from 2005 to 2017 were collected from "Pesticide Poisoning Report Card" . The data were analyzed and assessed by EpiData. The SPSS 22.0 software was used for statistical analysis. Results: During the thirteen years, there were a total of 8092 cases of pesticide poisoning, among which, the number of occupational pesticide poisoning was 1 408, accounting for 17.4% of the total number of cases, 14 patients died, the case fatality rate was 0.1%. There were 2, 992 cases of male poisoning, accounting for 36.97% of the total number of cases, and 5, 100 cases of female poisoning, accounting for 63.03%. There were 6684 non-productive pesticide poisonings, accounting for 82.6% of the total number of cases; 387 deaths occurred, and the mortality rate was 5.8%. Among non-productive poisonings, the incidence of oral pesticide poisoning was 84.3%, and the incidence of accidental poisoning by pesticides was 15.7%. Organophosphorus pesticides poisoning cases accounted for the majority of oral pesticide poisoning cases. The overall incidence of pesticide poisoning showed a downward trend. The age of non-productive pesticide poisoning cases was mainly 15-44 years old, and the number of cases of poisoning were 4 029 cases (60.28%) . With the increase of age, the mortality rate of poisoning cases was higher, especially for those over 60 years old who died of oral pesticide poisoning (40.1%) . The peak of pesticide poisoning began to increase in the second quarter and reached its peak in the third quarter. Conclusion: Although the cases of pesticide poisoning reported in Xuzhou City have been declining in recent years, the situation is still severe. The proportion of oral pesticide suicide accounts for a large proportion, and the mortality rate of elderly and female is relatively high, and the government should pay more attention. Workers should conduct safety education and psychological counseling to improve the knowledge and consciousness of safe use of pesticides.

Bone marrow mesenchymal stem cells: Aging and tissue engineering applications to enhance bone healing

Bone has well documented natural healing capacity that normally is sufficient to repair fractures and other common injuries. However, the properties of bone change throughout life, and aging is accompanied by increased incidence of bone diseases and compromised fracture healing capacity, which necessitate effective therapies capable of enhancing bone regeneration. The therapeutic potential of adult mesenchymal stem cells (MSCs) for bone repair has been long proposed and examined. Actions of MSCs may include direct differentiation to become bone cells, attraction and recruitment of other cells, or creation of a regenerative environment via production of trophic growth factors. With systemic aging, MSCs also undergo functional decline, which has been well investigated in a number of recent studies. In this review, we first describe the changes in MSCs during aging and discuss how these alterations can affect bone regeneration. We next review current research findings on bone tissue engineering, which is considered a promising and viable therapeutic solution for structural and functional restoration of bone. In particular, the importance of MSCs and bioscaffolds is highlighted. Finally, potential approaches for the prevention of MSC aging and the rejuvenation of aged MSC are discussed.

Ultrastructure of duck Tembusu virus observed by electron microscopy with negative staining

Duck Tembusu virus (DTMUV) is a newly emerging enveloped flavivirus. This study shows the ultrastructure of DTMUV using viral purification, negative staining and electron microscopy. Electron microscopic examinations revealed mature DTMUV particles with 50 to 75 nm in diameter and typical enveloped flavivirus structure that consists of the internal nucleocapsid, an inner layer of lipid bilayer and an external layer of E glycoprotein ectodomain. Particles appear to be mostly spherical. In particular, RNA core is deep colored and dense, both capsid and lipid bilayer are clearly visible, the capsid forms regular hexagon, and E glycoprotein ectodomain forms a fringe instead of visible spikes. Thus, this report about the clear ultrastructure of the DTMUV particles will be the major driving forces behind structural biology of DTMUV.

[Analysis of occupational poisoning in Jiangsu Province, from 2006-2015]

Objective: Analysis of occupational poisoning character and laws in Jiangsu Province from 2006-2015, so as to provide scientific basis for the formulation of effective intervention measures and prevention strategies. Methods: According to the data of Jiangsu province occupational poisoning cases reports of year 2006 to 2015, by EXCEL arranged, using SPSS software to do epidemiological data statistical analysis. Results: In the past ten years, the number of occupational poisoning cases reported in Jiangsu province increased first and then declined. 547 cases of acute occupational poisoning reported in Jiangsu province from 2006-2015 years (35.82% of the total poisoning cases, the same below) , 980 cases of chronic occupational poisoning (64.18%) . The ratio of male and female in acute poisoning was 2.48, while 1.55 of chronic poisoning. The cases of poisoning reported were young and middle-aged, and working years was mainly in 5 years. The cases reported in the south of Jiangsu (mainly is chronic poisoning) is higher than that in the northern part of Jiangsu (mainly is acute poisoning) , which is more economically underdeveloped.. The reported highest mortality rate of occupational poisoning is asphyxia gas poisoning (5.43%) , followed by irritating gas poisoning (2.99%) and organic solvent poisoning (0.47%) . Many more occupational poisoning cases reported from large, joint-stock enterprises, especially chronic poisoning. Meanwhile more cases of acute poisoning reported from small, micro private enterprises. Conclusion: Although a decline in occupational poisoning cases in Jiangsu, the prevention and treatment measures are still not lax. According to the species of toxic, regional economic differences, the scale of the enterprises and the type of economy, the characteristic key classification and prevention should be carried out. Expand the coverage of hospitals in the diagnosis and reporting of occupational poisoning diseases, and strive to improve the quality of occupational disease reports.

Aligned Scaffolds with Biomolecular Gradients for Regenerative Medicine

Aligned topography and biomolecular gradients exist in various native tissues and play pivotal roles in a set of biological processes. Scaffolds that recapitulate the complex structure and microenvironment show great potential in promoting tissue regeneration and repair. We begin with a discussion on the fabrication of aligned scaffolds, followed by how biomolecular gradients can be immobilized on aligned scaffolds. In particular, we emphasize how electrospinning, freeze drying, and 3D printing technology can accomplish aligned topography and biomolecular gradients flexibly and robustly. We then highlight several applications of aligned scaffolds and biomolecular gradients in regenerative medicine including nerve, tendon/ligament, and tendon/ligament-to-bone insertion regeneration. Finally, we finish with conclusions and future perspectives on the use of aligned scaffolds with biomolecular gradients in regenerative medicine.

Constraining the p-Mode-g-Mode Tidal Instability with GW170817

We analyze the impact of a proposed tidal instability coupling p modes and g modes within neutron stars on GW170817. This nonresonant instability transfers energy from the orbit of the binary to internal modes of the stars, accelerating the gravitational-wave driven inspiral. We model the impact of this instability on the phasing of the gravitational wave signal using three parameters per star: an overall amplitude, a saturation frequency, and a spectral index. Incorporating these additional parameters, we compute the Bayes factor (lnB_{!pg}^{pg}) comparing our p-g model to a standard one. We find that the observed signal is consistent with waveform models that neglect p-g effects, with lnB_{!pg}^{pg}=0.03_{-0.58}^{+0.70} (maximum a posteriori and 90% credible region). By injecting simulated signals that do not include p-g effects and recovering them with the p-g model, we show that there is a ≃50% probability of obtaining similar lnB_{!pg}^{pg} even when p-g effects are absent. We find that the p-g amplitude for 1.4  M_{⊙} neutron stars is constrained to less than a few tenths of the theoretical maximum, with maxima a posteriori near one-tenth this maximum and p-g saturation frequency ∼70  Hz. This suggests that there are less than a few hundred excited modes, assuming they all saturate by wave breaking. For comparison, theoretical upper bounds suggest ≲10^{3} modes saturate by wave breaking. Thus, the measured constraints only rule out extreme values of the p-g parameters. They also imply that the instability dissipates ≲10^{51}  erg over the entire inspiral, i.e., less than a few percent of the energy radiated as gravitational waves.